title: Diabetes Implementation of a Self-management Program in Resource Poor and Rural Community Clinics.
abstract: OBJECTIVE
  To evaluate the implementation of a brief diabetes self-management support intervention designed for resource-poor community clinics.
  
  
  METHODS
  The authors conducted a pilot study among patients with type 2 diabetes in 3 community clinics. The intervention consisted of research assistants introducing and reviewing a diabetes self-management guide, helping patients set an achievable behavioral action plan, and following up with 2 telephone sessions. The primary outcome was patients' success setting and achieving behavioral goals.
  
  
  RESULTS
  All participants set an action plan (N = 247); most focused on physical activity or diet (97%). The initial session took an average of 15 minutes. At 2 to 4 weeks, 200 participants were contacted; 68% recalled their action plan; and 84% of these achieved it. At 6 to 9 weeks, approximately half of those who completed the first call were reached for the second call. Of those who remained in the intervention, 79% recalled their action plan, and 80% of these achieved it. At the end of the study, 62% of those initially enrolled reported behavior change. Most participants who did not complete the intervention could not be reached for telephone follow-up.
  
  
  CONCLUSIONS
  Although only about a third of patients remained engaged through the 2 follow-up calls, most of those who did reported they had achieved their action plan. This pilot study provides insight into initiating brief diabetes self-management strategies in resource-poor community clinics. Although telephone follow-up was challenging, using the self-management guide and action plan framework, particularly during the initial clinic visit, helped focus patients on behavior change.
authors.affiliation: Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Seligman
authors.forename: Darren A
authors.initials: DA
authors.lastname: Dewalt
authors.forename: Daci J
authors.initials: DJ
authors.lastname: Platt
authors.forename: Cristalyn
authors.initials: C
authors.lastname: Reynolds
authors.forename: Donna F
authors.initials: DF
authors.lastname: Timm
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
keywords: community clinics; diabetes education; literacy appropriate education; self-management diabetes counseling